One can’t help but feel Dr Allen’s pain. In fact many of us have felt Dr Allen’s pain, although not to such a debilitating degree.
Dr Allen is a 36 year old dentist from Okotoks. In Dec 2007 he injured his back playing hockey. He spent all of 2008 and part of 2009 doing the rounds of physiotherapy, acupuncture, facet injections, and drugs. In May 2009 his specialist recommended surgery. There was one tiny snag—the surgery couldn’t be performed until June 2011.
Unable to tolerate another two years of agony, Dr Allen found a surgeon in Great Falls, Montana who agreed to perform the operation in Dec 2009 for the price of $77,000. Dr Allen feels much better now, and not simply because his wallet is $77,000 lighter.
After the surgery Dr Allen hooked up with John Carpay, a lawyer, who took Dr Allen’s case to the Alberta Court of Queen’s Bench. Mr Carpay argued that (1) the Supreme Court of Canada ruled in the Chaoulli case that a ban on private health insurance under Quebec law infringed Mr Chaoulli’s Charter right to security of the person, (2) Alberta’s ban on private health insurance is the same as Quebec’s ban and therefore is unconstitutional and (3) Dr Allen should be allowed to sue the government for reimbursement of his expenses as well as damages for irreparable harm to his health due to the delays in obtaining surgery.
Mr Carpay and his client lost.
The judge said…
Mr Carpay is not taking this defeat lying down. On his website he says Mr Justice Jeffrey ruled that Dr Allen could not rely on the Chaoulli decision and that Dr Allen would have to re-prove or re-demonstrate the Supreme Court’s finding that the government’s monopoly over healthcare imposes suffering (and sometimes death) on patients on wait lists.
This is an overstatement and simply not true.
The reason why Mr Carpay lost the case was that he failed to provide a lick of evidence to show that Alberta’s ban on private health insurance caused the two year delay in Mr Allen’s case.*
Mr Justice Jeffrey pointed to a number of alternative explanations for the delay including underfunding, mismanagement, shortage of doctors, a disproportionate incidence of this type of back injury, unexpected population increases or differences in the concentration and distribution of populations.
Furthermore there was no evidence to show that if private health insurance were available in Alberta, Dr Allen would have qualified for it, would have bought it and if the insurer had accepted the good dentist’s claim his wait time would have been shorter.
Evidence based decision making
The battle to privatize healthcare is fought on two fronts. First, private insurers are fighting for the right to augment taxpayer funded health insurance with private health insurance (for those who can afford it). Mr Justice Jeffrey’s decision in the Carpay case shut that down—at least for now.
Second, private healthcare providers are incrementally shifting healthcare provided in public facilities to private clinics where the services will be delivered more cheaply and more quickly (for those who can afford it), thereby reducing the load on the public system. It’s all about market efficiency.
But where is the evidence?
The Canary Report
Studies like Wendy Armstrong’s Canary Report** challenge the blind assumption that the private sector is more efficient than the public sector. Ms Armstrong conducted a study of cataract surgeries performed in Calgary, Edmonton and Lethbridge. All of the surgeries were funded by public dollars.
In Calgary 100% of the cataract surgeries were performed in private clinics, in Edmonton 20% of the surgeries were performed in private clinics, and in Lethbridge none of the surgeries were performed in private clinics. The wait times in Calgary (100% private) were the longest. The wait times in Lethbridge (100% public) were the shortest.
Ophthalmologists in all three centres charged the province the same government-mandated fee for the procedure; however Calgary ophthalmologists charged an additional fee for the more comfortable soft lens (an extra $250 to $750 per eye); Edmonton ophthalmologists charged about half that and the Lethbridge ophthalmologists implanted the soft lenses at no additional cost.
Bottom line: Ms Armstrong discovered that contrary to popular opinion, the privatization of cataract surgery increased costs and wait times. Anyone who studies market behavior will not be surprised by this—an entrepreneur who controls a significant chunk of the market will charge whatever the market will bear.
Stories are not evidence
Canadians cherish publicly funded and publicly delivered healthcare above everything else…period! A study conducted by the Environics Institute in 2010 found that 85% of Canadians ranked healthcare as the country’s most important national symbol, outpacing the Charter of Rights and Freedoms, the flag, national parks, “O Canada”, the RCMP, multiculturalism, Canadian literature and music, hockey (yes hockey!), bilingualism, the CBC, Ottawa and the Queen.***
There is no question that the Canadian healthcare system is under stress—we all have stories of poor outcomes resulting from chronic underfunding and the mismanagement of resources—however, as pointed out by Dr Danielle Martin who testified before the US Senate committee on Obamacare, “You don’t build a healthcare system based on stories.”****
The reverse is also true. You don’t tear down a healthcare system based on blind faith in free enterprise. Instead you follow Mr Justice Jeffry’s lead. You demand evidence to support the pitch that the free market can and will do a better job.
Either that or drive to Lethbridge for your cataract operation.
Disclosure: Ms Soapbox and Ms Armstrong have been friends since 2011.
*Allen v Her Majesty the Queen 2014 ABQB 184, starting at paragraph 39
**The Consumer Experience with Cataract Surgery and Private Clinics in Alberta: The Canary in the Mine Shaft, Jan 2000
***Chronic Condition by Jeffrey Simpson, p 270
****Calgary Herald April 5, 2014, A15